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To the Editor: In the meta-analysis by Dr De Luca and colleagues,¹ the authors concluded that in the setting of acute ST-segment elevation myocardial infarction (STEMI), adjunctive abciximab should be used in patients treated with primary angioplasty but not in those treated with fibrinolysis. The meta-analysis included 3 trials in which patients receiving either full-dose fibrinolytic drugs or a combination of half-dose fibrinolytic drugs plus abciximab were enrolled (ASSENT 3,² ENTIRE-TIMI 23,³ GUSTO V⁴).

In GUSTO V⁴, all patients received unfractionated heparin. In the ENTIRE-TIMI 23 trial³ and in the full-dose fibrinolytic group in ASSENT-3,² patients received either unfractionated heparin or enoxaparin (in the ratio of 1:2 in the former). Indeed, ENTIRE-TIMI 23 is a trial designed primarily to assess the efficacy of unfractionated heparin vs enoxaparin. For the 30-day composite end point of death/reinfarction, there was a statistically significant benefit demonstrated for enoxaparin vs unfractionated heparin in . . . [Full Text of this Article]

Daniel Shao-Weng Tan, BSc, MBBS; David Kheng-Leng Sim, MBBS, MRCP
Department of Cardiology
National Heart Centre
Singapore

Edwin Shih-Yen Chan, BSc, BVMS, PhD
Clinical Trials and Epidemiology Research Unit
Singapore

Ru-San Tan, MBBS, MRCP
Tan_Ru_San@nhc.com.sg
Department of Cardiology
National Heart Centre
Singapore

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